The applicability of add-on payment/reimbursement qualifiers/modifiers for emergency procedures should not be limited to patients’ emergency conditions alone. They should also be applicable to situations where arrangements are made for procedures outside regular office hours or on weekends. This includes cases where proceduralists choose to schedule procedures during after-hours or patients choose to have procedures during these times. Additionally, these qualifiers/modifiers should apply to proceduralists who work during after-hours or weekends due to inadequate resource allocation for elective procedures during office hours. Some examples of such scenarios include proceduralists being unable to complete elective procedures during office hours or the place being unable to perform emergency procedures without delaying or rescheduling office hours’ elective procedures to after-hours.
If all procedures during after-hours or weekends were reimbursed as emergencies, the triage of after-hours and weekend work emergencies would follow these preferences:
First preference would be given to patients with underlying conditions that require immediate attention, prioritizing the severity of the patient’s condition for the procedure.
Second preference would be given to proceduralists who have to work during after-hours or weekends due to inadequate resource allocation for office hours’ elective procedures.
Third preference would be given to patients who choose to have procedures during after-hours or weekends, accommodating the resources of the place.
Fourth and final preference would be given to proceduralists who choose to work during after-hours or weekends, with the agreement of the place and patient.
As anesthesia providers may not have control over when elective procedures are scheduled, anesthesia services provided during after-hours or weekends should universally be considered as emergencies, eligible for add-on payment/reimbursement qualifiers/modifiers, except in cases where delays in anesthesia are the cause of office hours’ elective procedures being completed or beginning during after-hours. It is important to note that while both places and proceduralists need to apply add-on payment/reimbursement qualifiers/modifiers for the first and third preferences mentioned above, only proceduralists need to apply them for the second preference, and only places need to apply them for the fourth and final preference.
This vision aims to protect patients’ health care by ensuring that billable emergencies never overshadow clinical emergencies during the triage of after-hours or weekend procedures. It also seeks to safeguard the well-being of health care providers by allowing billable emergencies to partially compensate for their lost personal time during after-hours or weekends. Moreover, this vision promotes financial balance for health care places by utilizing nonhuman resources during after-hours or weekends without exhausting human resources.
Paradoxically, this vision may inspire health care payers to regulate work during after-hours or weekends, ensuring that it remains allocated primarily for clinical emergencies, considering the varying degrees of immediacy dictated by the severity of patients’ underlying conditions.
Deepak Gupta is an anesthesiologist. Shushovan Chakrabortty is a pain physician.
